fMRI and Robot-Assisted Practices of Activities of Daily Living

描述(申请人提供)：中风是成人中最常见的后天神经功能障碍，女性中风的发生率高于男性。受影响的女性比男性更有可能因中风相关的残疾而活得更长。机器人辅助治疗代表了中风康复的前沿，并承诺改善因中风而致残的退伍军人的生活。使用这些工具的初步研究已经证明了其有效性和局限性的令人信服的证据。然而，可以看到这些收益不一致地结转到ADL。因此，目前还不清楚什么样的治疗策略能最大限度地提高ADLS的功能疗效。了解如何优化机器人辅助治疗对于增强患者康复和改善功能结果非常重要。功能磁共振成像(FMRI)和扩散张量成像(DTI)等成像技术可以帮助我们确定谁可以从机器人辅助训练中受益，以及为什么机器人训练后会发生训练引起的皮质功能变化。我们建议进行一项干预性研究加对照，以评估机器人辅助练习具有类似ADL的熟练功能任务的三周任务的有效性。我们将评估这种培训能否产生立竿见影的效果和长期的功能改进。此外，使用功能磁共振成像和DTI，我们计划将运动障碍水平和功能任务表现水平上的行为变化与白质损伤和连接以及运动皮质和大脑其他区域的氧气利用变化联系起来。我们假设如下：机器人辅助的熟练到达任务的练习改善了中风后的ADL功能。我们的短期目标是1)评估这些熟练任务的短期功能收益；2)评估这些改进的长期(6个月)维护；3)量化与机器人训练相关的中枢神经系统变化；4)根据皮质活动和白质连接类型的变化模式，确定高响应者和低响应者之间的趋势。我们的长期目标是1)优化练习ADLS的机器人训练策略，以最大限度地提高皮质变化的强度和持续时间，以及2)确定病变特征如何影响功能、白质连接和皮质活动的变化。

DESCRIPTION (provided by applicant): Strokes are the most commonly acquired neurological disability in adults and stroke rates are higher in women than in men. Affected women are more likely than men to live longer with their stroke-related disabilities. Robot-assisted therapy represents the cutting edge of stroke rehabilitation and promises to improve the lives of veterans with disabilities due to stroke. Preliminary studies using these tools have demonstrated compelling evidence of their effectiveness and limitations. However, inconsistent carryovers of these gains to ADLs are seen. Therefore, it is still not clear what treatment strategies maximize functional outcomes on ADLs. Understanding how to optimize robot-assisted therapies is important for enhanced patient rehabilitation and improved functional outcomes. Imaging techniques such as functional Magnetic Resonance Imaging (fMRI) and Diffusion Tensor Imaging (DTI) can assist us in determining who may benefit from robot-assisted training and why training induced functional cortical changes may occur after robot training. We propose to conduct an interventional study plus control to assess the effectiveness of three weeks of robot-assisted practice of tasks with skilled functional tasks that resemble ADLs. We will assess the ability of such training to effect immediate gains and long-term functional improvements. Further, using fMRI and DTI, we plan to associate behavioral changes seen in motor impairment levels and functional task performance levels with white matter injuries and connectivity and changes in oxygen utilization in the motor cortex as well as other areas of the brain. We hypothesize the following: Robot-assisted practice of skilled reaching tasks improves ADL function after stroke. Our short-term aims are to 1) assess short-term functional gains practice of these skilled tasks; 2) assess long-term (six months) maintenance of these improvements; 3) quantify the central nervous system changes associated with robotic training, and 4) identify trends across high and low responders in terms of patterns of change in cortical activity and type of white matter connectivity. Our long-term aims are to 1) optimize robot-training strategies for practice of ADLs for intensity and duration to maximize cortical changes and 2) determine how lesion characteristics affect changes seen in function, white matter connectivity, and cortical activity.